Secure e-Banking Enrollment Form
19-21 East Main Street, Westfield, NY 14787
Phone: (716) 326-3858  •  Fax: (716) 326-7550

Member Account Number:
First Name: Middle Name/Initial: Last Name:
Street Address: City: State: Zip Code:
Home Phone #: Cell Phone #: Work Phone #
Ext:
Last 4 Digits Of Social Security #: Birthdate (MM/DD/YYYY): Email Address:
 
By submitting this request, I acknowledge that I have read and agree to the terms of the Home Banking Disclosure